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When Mentally Ill Students Feel Alone

On January 25, 2015, Luchang Wang swiped into her residential college at Yale for the last time. It was a Sunday—a day that many Yale students spend in the library, stressed as they prepare for the week ahead. At some point in the next two days, Wang, a sophomore math major, left New Haven and boarded a plane for San Francisco, using a one-way ticket she had ordered online. She would not be coming back. At 1:26 p.m. on Tuesday, January 27, Wang posted a worrying status on Facebook that sent students and administrators frantically searching for her whereabouts. It read, in part:

Dear Yale: I loved being here. I only wish I could’ve had some time. I needed time to work things out and to wait for new medication to kick in, but I couldn’t do it in school, and I couldn’t bear the thought of having to leave for a full year, or of leaving and never being readmitted. Love, Luchang.

About five hours later, Jonathan Holloway, the dean of Yale College, informed the school via email that Wang had died in "an apparent suicide." A subsequent report by the Yale Daily News stated that a "despondent female" had jumped off the Golden Gate Bridge into San Francisco Bay. Although a backpack left on the bridge appeared to belong to Wang, the California Coast Guard couldn’t recover a body and thus couldn’t confirm that she had jumped. Remembered for her compassion, she was 20 years old.

"Upon release from the hospital … my Yale ID was confiscated, as was my room key. I was given one evening to pack up my entire life."

In the weeks following Wang’s death, Yale students have expressed grief and frustration—the latter because of the school’s withdrawal and readmission policies. These policies, some say, make it especially difficult for students with mental-health issues to feel comfortable leaving campus, even when taking time off from school may improve their wellbeing. According to several Yale undergraduates, some of whom asked for anonymity, there is a significant fear on campus that the administration will force mentally ill students to leave; there’s also a related fear that sick students will not be allowed to return. As a result, students suffering from anxiety, depression, and other disorders may not be getting the treatment they need. And for many of those who are, the question soon becomes: "How much should I open up?"

"The fact that [Wang’s] suicide note specifically mentioned the role of withdrawal and readmission policies was pretty inflammatory among undergraduates," said Caroline Posner, a sophomore at Yale who has advocated for mental-health reform on campus. "There are a number of people who are not seeking out help because of the threat that they will be withdrawn or hospitalized for their conditions. There’s no clear standard established that says exactly what students will get involuntarily hospitalized or withdrawn for. So people will lie to their therapists." (Wang had already withdrawn from and been readmitted to Yale once; the school’s policies state that a second readmission will only be considered "under unusual circumstances, ordinarily of a medical nature.")

But for various reasons, including Wang’s death and the media attention it received, the shortcomings of such policies are becoming increasingly visible at Yale. Last week, dozens of students at the Ivy League university confronted school officials at a town hall on mental health, framing their complaints in terms of fundamental fairness and transparency. Ultimately, what’s brewing at Yale illustrates that while individual experiences differ, school policies risk exacerbating students’ existing mental-health battles. At best, that can mean deepened uncertainty; at worst, it can mean being cut off from one’s college community.

Yale’s current policies state that undergraduates in good academic standing have until the 10th day of the semester to petition for a one- or two-term leave of absence. For students who wish to spend that time traveling or completing an internship, this provides an easy option to transition on and off campus: There’s no need to apply for readmission. But if a student has to leave Yale after that deadline, they must formally withdraw. (It doesn’t make a difference if they’re leaving for medical or personal reasons; it can be a diagnosis of cancer, a family emergency, or an onset of major depression.) Furthermore, if a student eventually wants to come back to Yale—a decision he or she may not be ready to make at the time—that person must satisfy several requirements after withdrawal.

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For at least a decade, these requirements have caused a good deal of consternation among many Yale students. The bylaws use vague language demanding that students be "constructively occupied" and maintain "a satisfactory standard of conduct" while away from campus—but fail to explicitly define what that means. Typically, though, this translates to undertaking a job or completing college courses. On top of that, students who withdraw for mental-health reasons may be required to seek counseling. Any undergraduate who applies for readmission must return to campus for interviews, which "are normally conducted just prior to the beginning of the term" that the student has reapplied for. Although these students are evaluated by a separate readmissions committee, their chances of getting back in may be affected by the general-applicant pool: Yale’s regulations state that the school can cap the number of students it readmits to control total undergraduate enrollment. (The readmissions-committee chairwoman, Pamela George, couldn’t be reached for comment.)

A more cynical interpretation is that Yale effectively treats those with serious mental-health conditions as liabilities rather than as members of the community.

A Yale spokesman, Tom Conroy, declined to specify the percentage of withdrawn students who are readmitted each year. But the school is more than happy to share how few students are accepted in the first place. Last year, Yale’s admissions rate for the class of 2018 was 6.26 percent—fewer than 2,000 high-schoolers were admitted from a pool of more than 30,000 applicants. This rate was in line with those at other elite schools: Harvard, Princeton, and Stanford accepted an average of 6.1 percent of applicants. Conroy indicated that the acceptance rate for readmission is much higher than that of regular applicants: "The way the policies play out is that the vast majority of students who withdraw are readmitted," he wrote in an email. "The purpose of the readmission process is to determine that the issue or issues that led to a withdrawal have been resolved and that the student will return and be successful and have a rewarding experience."

Still, students who have gone through Yale’s readmission process claim that it is mired in financial and logistical uncertainties. Outside courses cost money, and many schools will offer little or no financial aid to withdrawn students because they are typically only enrolled part-time. Moreover, students with mental illnesses may be required to seek specialized treatment, which can cost thousands of dollars, to prove they are healthy enough to return. As Alexa Little, a junior at Yale who left in 2013 and came back this past fall, recently told Bloomberg, "Students who get sick later in the term, or whose chronic health issues flare up unexpectedly, are treated as if they chose to fall ill and punished severely with financial burdens and this complicated process."

On paper, Yale’s readmission requirements seem reasonable, if a little vague. And the bylaws may be vague for a reason: They allow for individual circumstances to be taken into account. Meanwhile, studies show that students who leave school for mental-health reasons should generally seek treatment to get better. And the school has a valid interest in admitting people who can handle their coursework and graduate in a timely manner: Many high-schoolers compete in and outside of the classroom to get in.

Yet, a more cynical interpretation voiced by some students is that Yale effectively treats those with serious mental-health conditions as liabilities rather than as members of the community. A junior studying psychology at Yale who asked to remain anonymous said that the way Yale deals with mental health "creates a culture of shame and silencing and self-silencing," which makes it hard to "feel that you can speak openly and be heard as a student about mental-health issues." She added that Yale’s withdrawal and readmission policies make undergraduates unwilling to be open, above all in regards to suicidal thoughts, self-destructive behavior, and debilitating depression. Discussing these conditions, the student said, may lead officials to question whether a student should be at—or is fit for—Yale.

"It is almost taken as a given that no matter how distressing the thoughts [of self-harm] are, or how productive it might be to talk about them in a therapeutic session, bringing them up will most often result in hospitalization, unless you’re very delicate with your words," she said. "I know students who have been hospitalized involuntarily, or asked to take medical leave. When it happens involuntarily, the assumption is that you’re not capable of protecting yourself, or handling yourself, or even evaluating the state of affairs [you find yourself in] reasonably."

Yale’s policies state that the school can force students to withdraw for medical reasons when they pose "a danger to self or others," or refuse to cooperate with the administration’s efforts to make such a determination. This is standard across colleges and universities around the country. Yale refuses to comment on specific cases for confidentiality reasons, but student accounts of compulsory withdrawals in op-eds and online forums describe harrowing nights spent at Yale-New Haven Hospital, where undergraduates are taken in emergencies, as well as the various administrative and psychological challenges they faced when trying to return to campus. Last year, Rachel Williams—then a readmitted freshman at Yale—published an essay in the student newspaper recounting her experience of being hospitalized under school’s orders after cutting herself. She was eventually told she would have to withdraw from Yale and go home, with no guarantee of readmission. "Upon release from the hospital … my Yale ID was confiscated, as was my room key," Williams wrote. "I was given one evening to pack up my entire life." She returned to school in January 2014.

"There’s no clear standard ... that says exactly what students will get involuntarily hospitalized or withdrawn for. So people will lie to their therapists."

Although Williams's case may be extreme, such an outcome is what many students likely fear when meeting to discuss mental-health issues with school officials, such as a Yale clinician or academic dean. Tammy Pham, a senior who was friends with Luchang Wang, said many students at elite schools are so driven to succeed that taking a leave of absence does not feel like an option, even if doing so could be beneficial. As at similar schools, there is pressure at Yale to always appear happy or "okay." Pham added that she hopes Yale will remove obstacles to withdrawal and readmission for students, such as the requirement to take courses while away from Yale and the need to declare a leave of absence within the first 10 days of any given semester.

"Basically, the only difference between a leave of absence and withdrawal is foresight, and yet it has massive repercussions," she said. "Ten days seems arbitrary and restrictive."

For its part, Yale in December formed a six-person committee to start reviewing its withdrawal and readmission policies. And in late January, just days after Wang’s death, the university sent a letter to recently readmitted students asking for their "feedback and advice" about the entire withdrawal and readmission process. (It’s unclear whether the letter was sent in direct response to Wang’s death; it was leaked by a readmitted student on Facebook in early February, and the committee’s chairman deferred comment to Conroy, Yale’s spokesman.) Among the questions included in the letter: "Was your decision to withdraw from Yale College affected by your concern for readmission?" and "Did you understand the conditions, if any, of readmission, such as the holding of a job, enrollment in college courses, or therapeutic or medical treatment?" Conroy could not say how long the review will take.

Students have called for changes to Yale’s mental-health policies, resources, and environment for some time now. But undergraduates like senior Geoffrey Smith have recently amplified those calls, supporting a boycott of the annual senior-class fundraising campaign until Yale makes its procedures for withdrawal and readmission less stringent; the campaign has seen an 18.6 percent drop in fundraiser participation this year as compared to 2014. In an email, Smith pointed to recommendations made by student leaders last March as "a precise set of serious and reasonable reforms" for how Yale could ease the burden of taking time off. These include allowing students to take a voluntary leave of absence at least until midterm; for comparison, Harvard College allows students to do so until the seventh Monday of the term. Other reforms include determining requirements for return "tailored to the students’ needs," considering students’ financial means on a case-by-case basis, and informing students of whether they’ve been readmitted to Yale at least one month before their return. If students who withdraw could return to campus more easily, Smith wrote, the fear of involuntary withdrawal would be less "existential," and would not "throw students into [a] terrifying mess."

"Unfortunately, sometimes it takes a death for people to come together and realize there’s a problem. But now, we need to focus on those who are still living."

The debate at Yale comes at a time when mental-health issues are on the rise at schools nationwide. A recent UCLA survey of more than 150,000 college freshmen nationwide found that nearly 10 percent of respondents had "frequently" felt depressed in the past year, up from 6.1 percent in 2010; additionally, respondents rated their emotional health at an average of 50 percent, the lowest level in the survey’s five-decade-old history. Likewise, in 2012, the Association for University and College Counseling Directors revealed that 70 percent of officials who completed its annual member survey said that the number of students on their campus with "severe psychological problems" had increased since the year before. It’s worth noting that at Yale, nearly 40 percent of undergraduates use the school’s mental-health resources before graduating—a demand that, some students claim, has caused long wait-times for appointments and is believed to take a toll on the quality of care.

Victor Schwartz is a psychiatrist who has been studying the mental health of young adults for years. As medical director of the Jed Foundation—a nonprofit devoted to preventing suicide among students enrolled in higher-ed institutions—Schwartz knows of many schools that provide excellent mental-health resources but aren’t doing enough to market and promote them. The popular perception of withdrawal and readmission policies, he added, is as important as the policies themselves: If students believe that they’re punitive or rigid, fewer people will come forward with their problems. "The school has an obligation to offset that negative information," Schwartz said. "Schools are at a disadvantage here for confidentiality reasons; they can’t go out there and say that a particular student’s situation is completely inaccurate in what’s been reported in the school newspaper. But if you’ve accepted a student, you’ve made a certain type of commitment to make sure the student gets to the finish line."

Pham, the Yale senior who knew Wang, says students shouldn’t focus on assigning blame to the school; instead, they should work toward fostering a more positive environment on campus for their peers’ emotional wellbeing. This solution would certainly require updating Yale’s withdrawal and readmission policies, she said. But she believes that students’ concerns can be addressed—at least in part—by improving peer-support systems and promoting education about mental health: a mental-health fellows program, increased communication from the school’s health officials, and workshops during freshmen orientation, for example.

"Yale has the opportunity to lead the way universities treat mental health," Pham said. "It has a lot of power, a lot of visibility. Unfortunately, sometimes it takes a death for people to come together and realize there’s a problem. But now, we need to focus on those who are still living."